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Dear Dr.Saltzman,

I just turned 22 years old, and I live in Ontario, Canada. I will first try to give you a brief understanding of my childhood so that maybe you can understand me a little bit, I will try to make this as short as possible.
I moved out on my own a few years ago now for school living in residence, and have been living in my own apartment for 2 years now. When I was younger, I was diagnosed with Obsessive Compulsive Disorder. I was a 'checker' if you want to call it that, and I would constantly check to see if I turned the stove off, unplugged the straightner, emptied the dryer from ANY fluff possible, and I would do things like this repeatedly, all the time through out highschool. It would take me at least 45 minutes to walk to school when it was a 10 minute walk because if I stepped on a certain rock, I would do it again, and again and again. I would tell myself if I didn't something bad would happen. If I didn't hear what you said, exactly.. I would repeatedly ask the question again and again to the point that people were getting upset with me. I was also a germaphobe, and I was always making sure things were 'just so'. I was really, really annoying and my mother always thought I was doing things intentionally to bother her, but the fact was that if I didn't do certain things, I would actually break down.

It got to the point that when I was dating my boyfriend of 2 years in highschool, I couldn't even watch television or bump into another male at school without thinking that I was cheating on him. In my mind I deep down knew I wasn't, but I couldn't get it out of my head and would have to inform him of ANYTHING like that, that I did..It was horrible.
I was put on a medication called fluvoxamine when I was about 16, and it helped a lot and over time my 'ticks' started to go away less and less. I started to finally live a normal life for the next few years, my ocd would come and go as it pleased but with enough cognitive behavioural therapy, etc I was able to at least be in control of my life.

About 2 years ago now, my OCD started making small appearances in my life. I lived a fairly normal teenage life, I didn't excessively drink, or do drugs but I did try drugs a few times and smoked marijuana sometimes as well but I was never, ever an addict to anything. I tried ecstasy and cocaine a few times, mostly in my first year of college. I can honestly say that it was never a huge thing, and I only did it a few times but I feel it necessary to talk about just incase it has anything to do with how I am feeling now. However, one night after doing one line of cocaine I had my first panic attack. It was the scariest, worst thing I have EVER been through. I haven't touched it since, and it has been almost 2 years now. Since then, I have had such bad panic attacks, and anxiety. SUCH severe anxiety, I can't even begin to explain. Last year around this time I had swine flu, and during that time I had such bad anxiety and because of my heart rate was in and out of the hospital like you wouldn't believe. I was sick in bed for almost a month and a half, and was later put on sick leave due to my illness of swine flu, and my doctor 'diagnosed' me with severe panic disorder. Which has been only the beginning to my nightmare. I started taking a pill called Cipralex which seemed to help intensely, but only for short periods of time and then its like it wares off or something. I also have lorazapam for onset anxiety, but I only take it when needed. My panic attacks have reduced a significant amount, but now my OCD is back in full force and ruining my life. A few weeks ago they changed my medication to Wellbutrin XL, because some side effects of cipralex I disliked. Around that time my friend's uncle died, and she called to talk to me about it and I tried to comfort her any way I could and afterwards, all I could find myself doing was thinking about dying. Death was constantly on my mind, and even know just typing it I can feel my self beginning to panic. I can't get it out of my head. All I think about, all day is dying. What its like, what it feels like, how everyone is just so comfortable with it, and why all of a sudden I'm having such an issue with it. I realize its a part of life, but I can't seem to get it out of my head and its gotten to the point that I can't sleep, eat, be touched. It is ruining my relationship with my boyfriend, and causing me such stress in my life that I had to quit my job at a retirement home because I just couldn't bear working with people that were so fragile and old without panicking. My parents are so disappointed in me, and I feel as if noone understands what I'm going through. I actually, seriously feel like I am going insane. I will just be sitting there, and start thinking the weirdest thoughts.. I will think that every day normal things, are strange and awkward. I am starting to scare myself. I went off Wellbutrin about 2 weeks ago now, and have started Cipralex again and it has helped a little but I am still awake at all hours of the night. (right now it is 2 am) I can't just 'clear my head' or 'not think about it' as millions like to tell me to do. I just want to feel normal again, and have passion for things in life, and want to wake up in the morning. Instead, I am feeling as if everything is pointless because one day I am just going to get old, and DIE. I am so scared. I have no thoughts of hurting myself, as I am far too afraid of the thought of dying, but I just don't know what to do anymore.

I'm afraid I am going to have to admit myself to some kind of mental institute. I know I am young, but I just don't feel okay..

Please HELP.
I am so sorry for the huge novel I have written, I have so much going through my head. If you do not have time to write back, I understand.
Thanks for reading,


Hello, Amanda--

I am sorry to hear about all this suffering. Obsessive-Compulsive Disorder (OCD) usually is understood as having a genetic basis, and the treatment you have received—a combination of medication and cognitive behavioral therapy (CBT)--is widely considered the most effective way to deal with it. Apparently, that combination of therapy and medication did work reasonably well for you for a while, so I suggest right off the bat that you get back into therapy right away, and also ask the doctor who has been prescribing your medication to try another substance which might work better in controlling your symptoms.

It is possible that your experiment with cocaine triggered the panic attack, so, obviously, you should not mess around with any "recreational" drugs again.

Fear of death is a common human experience. So is the thought that, since some day I will die, there is no point in living. Both of these kinds of suffering need to be addressed not with drugs, but by means of psychotherapy and/or some kind of philosophical or spiritual healing practice. In your case, which is complicated by your tendency to obsess on your thoughts, and to become compulsive in trying to deal with them, I would recommend that you look for a psychotherapist with whom you can meet on a regular basis—perhaps several times a week at first. If you can do this as an outpatient, so much the better, but a hospital setting, at least for a short time, could also provide the kind of care you need.

Be well.

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